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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006190
Report Date: 09/23/2024
Date Signed: 09/23/2024 12:14:16 PM

Document Has Been Signed on 09/23/2024 12:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:4CS WINDSOR STATE PRESCHOOLFACILITY NUMBER:
493006190
ADMINISTRATOR/
DIRECTOR:		MICHELLE MARTINFACILITY TYPE:
850
ADDRESS:79 PLEASANT AVENUETELEPHONE:
(707) 836-7068
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 16DATE:
09/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Michelle MartinTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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A required inspection was made to the facility by Licensing Program Analyst (LPA), Glenn Ouye. LPA met with facility representative, Site Supervisor, Michelle Martin. Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The 4C’s Windsor State Preschool is a Title 5 funded program. The operating hours are 7:00am to 5:30pm, Monday through Friday. This program is a preschool program which operates at the Mattie Washburn Elementary School. The program operates within two connected classrooms. The facility was toured inside and outside, and the floor and yard plans submitted were verified. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The Site Supervisor stated there are no poisons in the facility, and none were observed during this inspection. LPA observed the toys, floors, desks and other equipment and surfaces are clean, toxic free, safe, and in good condition.

Continued on LIC 809-C.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: 4CS WINDSOR STATE PRESCHOOL
FACILITY NUMBER: 493006190
VISIT DATE: 09/23/2024
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There is uncontaminated drinking water available to children indoors and outdoors. The children use water bottles while outside. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the Site Supervisor’s office. The food/meals are prepared on site by teachers. Menus are posted in the entry of the classroom. There is a working smoke detector, carbon monoxide detector and multiple fire extinguisher rated at least 2A10BC in the classroom. LPA observed the playground equipment and surface areas were in safe condition.

A wood chip cushioning under the climbing structure is used to absorb falls. There were no bodies of water observed on the site.

During today's inspection, staffing ratios were being met, a total of 16 preschool children were being supervised by six staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the visit possessed current CPR and First Aid certifications which was valid through September 2026.

Five children’s records were reviewed and contained complete and current information as required. Three staff files were reviewed and contained all records as required.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance wtih the Written Directives outlined in PIN 21-21.1-CCP.

No deficiencies cited during todays inspections.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
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